血尿酸与肾小球滤过率的交互作用对腹膜透析患者全因及心血管事件死亡的影响  

Effect of the interaction between estimated glomerular filtration rate and serum uric acid on all-cause and cardiovascular mortality in patients on peritoneal dialysis

作　　者：肖希 叶红坚[1,2] 彭媛[1,2] 易春燕[1,2] 林建雄[1,2] 余学清 阳晓[1,2] Xiao Xi;Ye Hongjian;Peng Yuan;Yi Chunyan;Lin Jianxiong;Yu Xueqing;Yang Xiao(Department of Nephrology,the First Affiliated Hospital,Sun Yat-sen University,Guangzhou 510080,China;Key Laboratory of Nephrology,Committee of Health,Guangzhou 510080,China;Guangdong Provincial People's Hospital,Guangzhou 510080,China;Guangdong Academy of Medical Science,Guangzhou 510080,China)

机构地区：[1]中山大学附属第一医院肾内科,广州510080 [2]中山大学附属第一医院国家卫生健康委员会肾脏病临床研究重点实验室,广州510080 [3]广东省人民医院,广州510080 [4]广东省医学科学院,广州510080

出　　处：《中华肾脏病杂志》2020年第9期703-710,共8页Chinese Journal of Nephrology

基　　金：国家自然科学基金(81774069、81570614);国家重点研发计划项目(2016YFC0906100);广东省医学科学技术研究基金项目(A2018042、2017A050503003、2017B020227006)。

摘　　要：目的探讨血尿酸与估算肾小球滤过率(estimated glomerular filtration rate,eGFR)的交互作用对腹膜透析患者全因及心血管事件死亡的影响。方法纳入2006年1月到2016年12月在中山大学附属第一医院腹膜透析中心新置管的患者,收集患者的人口学、基线临床和实验室检查结果等资料,随访至2018年12月。应用Kaplan-Meier生存曲线及Cox回归分析探究不同eGFR组间尿酸与患者全因及心血管事件死亡的相关性。结果共纳入2124例腹膜透析患者,年龄(47.0±15.2)岁,其中男性1269例,糖尿病患者536例,血尿酸为(429±96)μmol/L,eGFR为6.69(5.17,8.61)ml·min-1·(1.73 m2)-1。经过中位42个月的随访,554例腹膜透析患者死亡,其中275例为心血管事件死亡。Cox回归分析结果显示血尿酸及eGFR与患者全因死亡存在交互作用(P=0.043)。Kaplan-Meier生存曲线结果显示,与中三分位组(血尿酸384~460μmol/L)相比,高eGFR组[eGFR>6.69 ml·min-1·(1.73 m2)-1]中低三分位组(血尿酸<384μmol/L)及高三分位组(血尿酸>460μmol/L)病死率显著增加(χ2=9.338,P=0.009),而在低eGFR组中则无统计学意义。校正相关人口学资料、合并症、生化结果等指标后,在高eGFR组患者中,血尿酸每增加1μmol/L,患者全因死亡风险增加0.2%(HR=1.002,95%CI 1.000~1.003,P=0.019);与血尿酸中三分位组相比,高三分位组患者与较高的全因死亡风险独立相关(HR=1.670,95%CI 1.242~2.245,P=0.001)。结论eGFR和血尿酸与腹膜透析患者全因死亡存在交互作用,高eGFR组中较高的血尿酸水平是腹膜透析患者全因死亡的独立危险因素。Objective To explore the effect of the interaction between estimated glomerular filtration rate(eGFR)and serum uric acid(SUA)on all-cause and cardiovascular mortality in patients on peritoneal dialysis(PD).Methods Patients who performed PD catheterization at the PD center of the First Affiliated Hospital of Sun Yat-sen University and had initiated PD therapy for over 3 months from January 2006 to December 2016 were enrolled and followed up until December 2018.Demographic data,baseline clinical and laboratory examination results of the patients were collected.Kaplan-Meier survival curve and Cox regression analysis were used to explore the correlation between SUA and all-cause mortality,cardiovascular mortality in different eGFR groups of PD patients.Results A total of 2124 PD patients were enrolled with age of(47.0±15.2)years,among whom 1269 patients were male and 536 patients had diabetes.The SUA level was(429±96)μmol/L and the median level of eGFR was 6.69(5.17,8.61)ml·min-1·(1.73 m2)-1.After a median follow-up time of 42 months,554 patients died,among whom 275 patients were cardiovascular death.The Cox regression analysis revealed that there was a significant interaction between eGFR and SUA on all-cause mortality(P=0.043).The Kaplan-Meier curve showed that the tertile 1(SUA<384μmol/L)and tertile 3(SUA>460μmol/L)group had significantly higher all-cause mortality(P=0.009)than the reference group of tertile 2(SUA 384-460μmol/L)in the higher eGFR group[eGFR>6.69 ml·min-1·(1.73 m2)-1]but not in the lower eGFR.After adjusting for relevant demographic data,complications,biochemical results and other variables,in patients with higher eGFR,the risk of all-cause mortality increased by 0.2%(HR=1.002,95%CI 1.000-1.003,P=0.019)for every 1μmol/L increase in SUA.In addition,compared with the tertile 2 reference group,the tertile 3 group was independently correlated with higher risk of all-cause mortality(HR=1.670,95%CI 1.242-2.245,P=0.001).Conclusions The eGFR and SUA level significantly interacts with all-cause m

关 键 词：腹膜透析 尿酸 肾小球滤过率 死亡率 心血管事件死亡 

分 类 号：R692.5[医药卫生—泌尿科学]